Provider Demographics
NPI:1336996750
Name:IVORY DENTAL CARE
Entity type:Organization
Organization Name:IVORY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PRASANNATA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRADHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-640-1519
Mailing Address - Street 1:436 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-2339
Mailing Address - Country:US
Mailing Address - Phone:914-968-3330
Mailing Address - Fax:914-457-3960
Practice Address - Street 1:436 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-2339
Practice Address - Country:US
Practice Address - Phone:914-968-3330
Practice Address - Fax:914-457-3960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental